Provider Demographics
NPI:1386471852
Name:BERTOLAS, JANET SUE
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:SUE
Last Name:BERTOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:SUE
Other - Last Name:BERTOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR BERTOLAS
Mailing Address - Street 1:6575 141ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4937
Mailing Address - Country:US
Mailing Address - Phone:763-300-0114
Mailing Address - Fax:
Practice Address - Street 1:809 MEANDER CT
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-4549
Practice Address - Country:US
Practice Address - Phone:952-999-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist